COURTESY PHOTO
Iolani graduate Dr. Garrett Matsunaga, a surgeon at South Bay Urology Medical Group in Torrance, Calif., sits next to a da Vinci Surgical System machine. He is a proctor for Intuitive Surgical, which makes the robotic da Vinci, and will come to Hawaii to train doctors at the Queen's Medical Center on the system. The robot at Queen's will initially be used for prostate cancer surgery. CLICK FOR LARGE

Robot to aid surgeries at Queen's

The da Vinci system will first be used on prostate cancer cases

A robot called "da Vinci" will begin work with surgeons this week at the Queen's Medical Center.

The $1.5 million system will be used initially for prostate cancer surgery, said Dr. Kenric Murayama, chief of the Minimally Invasive Department. After those cases, he said he will use the robot for a gastric bypass operation.

The robotic system has been used for a variety of minimally invasive or laparoscopic surgical procedures performed through tiny incisions. They include hysterectomies, kidney transplants, gastrointestinal and esophageal surgeries, and even heart bypasses.

Mainland surgeons who have used the robot say it has revolutionized surgery.

Its most valuable application now is for prostate cancer, he said. Roughly 50 to 60 prostate surgeries are done at Queen's a year and "the goal is to increase that volume," Murayama said.

A strong advocate of the robotic technology is Dr. Garrett Matsunaga, a 1991 Iolani School graduate now practicing at the South Bay Urology Medical Group in Torrance, Calif.

He also is a proctor for Intuitive Surgical, manufacturer of the da Vinci system, helping surgeons learn to use it for prostatectomies. He will assist with the first cases at Queen's.

He specialized in prostate cancer and trained on the da Vinci system during his residency at the University of California, Irvine. He stayed an extra year on a fellowship to train with Dr. Thomas Ahlering, chief of urological oncology at UC Irvine Medical Center and a world leader in robotic techniques.

Matsunaga said in a telephone interview that two hospitals where he does surgery have da Vinci robots and he averages one to two cases a week at each hospital. Patients have less blood loss, less pain and faster recovery, he said. They go home within 24 hours after surgery and are back to work in three to seven days, he said.

It's a big difference from open surgery, which usually involves two to three days in the hospital, considerable pain, and four to six weeks recovery before they can go back to work, Matsunaga said.

Long-term data aren't available, but short-term data show prostate cancer patients have less incontinence or leaking of urine and sexual function returns faster with robotic surgery, he said. "It's not uncommon for a patient to say within three to six months they're getting some return function."

The robot is called "da Vinci" partly for Leonardo da Vinci, who invented the first robot and used "unparalleled anatomical accuracy and three-dimensional details to bring his masterpieces to life," according to Intuitive Surgical.

The "da Vinci" has four interactive robotic arms and "EndoWrist" instrument tips that the surgeon moves like hands. They angle in a way the human wrist can't for tiny incisions, Murayama said.

In normal laparoscopy operations, the surgeon stands and uses hand-held, long-shafted instruments and looks at a two-dimensional video monitor to see the target anatomy.

With the da Vinci system, the surgeon sits at a console near the patient and manipulates the instruments with high-resolution, 3-D vision.

"I think it's a great thing for us and hopefully for the people of Hawaii, and they will benefit from Queen's making an upfront investment for getting the robot," Murayama said.

"It's a huge investment for any hospital to make," Matsunaga said. Besides the robot, costs involve a $100,000-a-year service contract and robotic instruments costing $2,000 to $3,000, he said.